One-year test-retest reliability of ten vision tests in Canadian athletes

Mehdi Aloosh,Suzanne Leclerc,Tibor Schuster,Stephanie Long,Russell Steele,Ian Shrier,James M Brophy,Guowei Zhong

doi:10.12688/f1000research.19587.5

Abstract

Background: Vision tests are used in concussion management and baseline testing. Concussions, however, often occur months after baseline testing and reliability studies generally examine intervals limited to days or one week. Our objective was to determine the one-year test-retest reliability of these tests. Methods: We assessed one-year test-retest reliability of ten vision tests in elite Canadian athletes followed by the Institut National du Sport du Quebec. We included athletes who completed two baseline (preseason) annual evaluations by one clinician within 365±30 days. We excluded athletes with any concussion or vision training in between the annual evaluations or presented with any factor that is believed to affect the tests (e.g. migraines). Data were collected from clinical charts. We evaluated test-retest reliability using Intraclass Correlation Coefficient (ICC) and 95% limits of agreement (LoA). Results: We examined nine female and seven male athletes with a mean age of 22.7 (SD 4.5) years. Among the vision tests, we observed excellent test-retest reliability in Positive Fusional Vergence at 30cm (ICC=0.93) but this dropped to 0.53 when an outlier was excluded in a sensitivity analysis. There was good to moderate reliability in Negative Fusional Vergence at 30cm (ICC=0.78), Phoria at 30cm (ICC=0.68), Near Point of Convergence break (ICC=0.65) and Saccades (ICC=0.61). The ICC for Positive Fusional Vergence at 3m (ICC=0.56) also decreased to 0.45 after removing two outliers. We found poor reliability in Near Point of Convergence (ICC=0.47), Gross Stereoscopic Acuity (ICC=0.03) and Negative Fusional Vergence at 3m (ICC=0.0). ICC for Phoria at 3m was not appropriate because scores were identical in 14/16 athletes. 95% LoA of the majority of tests were ±40% to ±90%. Conclusions: Five tests had good to moderate one-year test-retest reliability. The remaining tests had poor reliability. The tests would therefore be useful only if concussion has a moderate-large effect on scores.

Highlights

Concussion, a form of mild traumatic brain injury is a growing public health concern[1]
For Phoria at 3m, we found that the Intraclass Correlation Coefficient (ICC) and limits of agreement (LoA) were not appropriate measures of reliability because most of the population reported identical scores of zero for both measurements
This level of reliability is useful in conditions which produce a moderate change in vision function

Summary

Introduction

Concussion, a form of mild traumatic brain injury is a growing public health concern[1]. Estimates suggest up to 3.8 million sport-related concussions occur annually in the United States, with 50% going unreported[2]. Vision tests are used in concussion management and baseline testing. Concussions, often occur months after baseline testing and reliability studies generally examine intervals limited to days or one week. Methods: We assessed one-year test-retest reliability of ten vision tests in elite Canadian athletes followed by the Institut National du Sport du Quebec. We excluded athletes with any concussion or vision training in between the annual evaluations or presented with any factor that is believed to affect the tests (e.g. migraines). We observed excellent test-retest reliability in Positive Fusional Vergence at 30cm (ICC=0.93) but this dropped to 0.53 when an outlier was excluded in a sensitivity analysis.

Objectives

Results

Discussion

Conclusion